Stomach fills with air

I have an AHI of 17.5 measured at an in-facility sleep study. The report shows no sleep at pressures 3, 4, 5, 6, or 7, and then 3 minutes of sleep at 9. The sleep study showed that I slept for 54 minutes with 25.9% REM when the CPAP was set at 11 so that is what they set up for me to use at home. I think I was awake during the study - I was aware of the mask continually leaking. I have read that people think they do NOT sleep during the sleep study but the equipment shows that they are sleeping. I think I was just laying still and the equipment detected sleep. How does the equipment differentiate between wake and sleep?

The report also shows no use of a bilevel machine. I know that the technician tried a bilevel machine and it was hard to synchronize my breathing with it. Is it standard for a technician to use a bilevel machine and then not include that in the report if the person did not tolerate it very well? Maybe I got someone else's report.

So far I have not been able to tolerate the equipment. I am trying it in the daytime and at night. I have tried a ResMed 10 set at 4-20 and couldn't get it up to adequate pressure to breathe. I feel like I am suffocating. Now I have a Phillips Dreamstation set on 11. I have tried different masks. I have tried it with and without the ramp. I breathe through my mouth and the nasal pillows and partial masks don't seem to work. I have a beard and it is hard to get a seal. Most recently, using the full mask with the straps on tight enough to stop the leaks, it filled my stomach with air making it so I was unable to breathe. It took 30-60 minutes to recover from that and be able to breathe normally. I tried a PureSleep dental appliance and it makes me gag. I am not sure what to do next. I have a call in to Pulmonology and to the CPAP supplier's respiratory therapist. Maybe I am just not going to be able to tolerate this.

A few points to consider.

1. The titration test using different pressures is to determine how much pressure you need to stop the obstructive apnea events. It is not about making you sleep.
2. A BiLevel machine is typically only used if the APAP cannot provide enough pressure, i.e. more than 20 cm.
3. The ResMed machine is probably better than the DreamStation and it can be easily set to a fixed pressure.
4. The main reason people feel like their suffocating is when the low pressure and ramp start pressure is set too low. For example the 4-20 cm you tried on the ResMed is too low. I would suggest minimum pressure should not be less than 7 cm.
5. A nasal pillow mask typically works best with a beard. That said my son has a full beard and uses a full face mask while tolerating the leaks.

My thoughts would be to try a nasal pillow mask with the ResMed machine set to 7 cm minimum and 12 maximum to see if that works for you.

I'm sorry you are currently not getting the treatment you seek. I think there is something for you that might take a few tries to find. I'll share my recent experience.

Recently I tried a new ResMed BiPAP trial machine plus new medium full face masks and had the awful experience of acid reflux at around 6:30am each day. The pain would last 6 hours and it felt like either a collapsed lung or heart attack would feel like. (I didn't have this problem while using my old Philips System One CPAP and large ResMed Quattro Air full face mask, but I was limited to 18 because my leak would be even worse than the 73% leak I had shooting too much in my eye.) I cranked it up to 25 inhale and 20 exhale and still had the problem. The machine would only push inhale if I triggered it. I really wanted it to sense my breathing rhythm and keep it going, but I guess they are not designed to do that. I even tried 25 inhale and 25 exhale to simulate max force CPAP and then even switching to CPAP mode at 20. I could not feel the extra pressure above 20. Honestly it felt like it was relative as if the 25 BiPAP == 20 CPAP. (I can tell the difference between 18, 19, 20 on my CPAP machines, so I am confused with the BiPAP.) The medium mask was too small because it barely would let me open my mouth before causing a leak.

I went back to my doctor and I told her that BiPAP doesn't work for me and the mask wouldn't let my mouth open to a natural degree. I was fitted with the large ResMed AirFit F20 and given a ResMed AirSense 10. This mask finally fits correctly which I think is the biggest contributor of the problems. I was able to set my machine to 19 and 20 without a leak, but I currently have it at 19 now. I'm able to get a great sleep pattern now. I also needed to turn off SmartStart because it would shut off on me even though there was no leak.

My doctor is surprised at my settings. No ramp, 18+ pressure. "That's a lot of pressure." ResMed still takes 10 seconds to ramp. Philips had a true 0 second ramp which I'll miss. I've tried low or average settings: I felt like it was full suffocation. I feel real comfort with my extreme settings and enjoy sleeping/napping/hanging out awake with the machine. I think if you can enjoy your settings while awake, it should then work well during sleep.

There is nothing wrong with the Philips System One. It just doesn't have "WiFi" so I couldn't get remote monitoring. I will definitely keep it as a backup/travel unit. I think the correct mask is the biggest factor in all of this.